Electronic Verification Visit Impacts: Baylor Scott & White and FirstCare Managed Care Organizations End Participation in Texas Medicaid Managed Care Effective Aug. 31

By August 31, 2026: (1) Billing team must identify all active patients with Baylor Scott & White plan codes (50, W4, C3) or FirstCare plan codes (50, W4, C3) in the billing system and EVV records. (2) Determine which MCO each affected member transitioned to using the Medicaid Client Portal or 270/271 eligibility inquiry, cross-referencing their service delivery area (Lubbock, MRSA West, or MRSA Central) against the replacement plan codes (WellPoint codes 53, W2, C1 or Superior codes 52, W3, C2). (3) Billing team must create new authorizations in the EVV system for all transitioned members using the new MCO's plan code, effective September 1, 2026, and manually enter them into EVV before the transition date. (4) Update billing software configuration to route claims for dates of service on or after September 1, 2026 to the new MCO payer (WellPoint or Superior) rather than the terminated plans. (5) If using third-party billing vendors, notify them immediately of the plan code changes and MCO transitions. (6) Continue using current authorizations through August 31, 2026 for any services rendered. Failure to update plan codes and authorizations will result in claim denials or routing to incorrect MCOs.